體外沖擊波治療非鈣化性岡上肌肌腱炎療效觀察

谷玉靜 林 松 馮曉東

. 骨科康復(fù) Orthopedic rehabilitation .

體外沖擊波治療非鈣化性岡上肌肌腱炎療效觀察

谷玉靜 林 松 馮曉東

目的 觀察體外沖擊波治療非鈣化性岡上肌肌腱炎的臨床療效。方法2011 年 4 月至 2013 年4 月，我科收治的非鈣化性岡上肌肌腱炎患者 53 例，平均年齡 ( 40.42±1.33 ) 歲，分為治療組 26 例和對(duì)照組 27 例。兩組均采用紅外線基礎(chǔ)治療，治療組在基礎(chǔ)治療上進(jìn)行小劑量體外沖擊波治療，對(duì)照組在基礎(chǔ)治療上采用沖擊波安慰治療。治療前和治療后 1 個(gè)月、3 個(gè)月，兩組均采用 Constant-Murley 肩關(guān)節(jié)功能評(píng)定法( constant-murley score，CMS ) 進(jìn)行功能評(píng)定。結(jié)果兩組均進(jìn)行了至少 3 個(gè)月的隨訪，無(wú) 1 例在治療過(guò)程中出現(xiàn)嚴(yán)重的副作用。治療組各指標(biāo)由治療前的疼痛 ( 2.08±0.80 ) 分、日常生活能力 ( 8.65±1.65 ) 分、關(guān)節(jié)活動(dòng)度 ( 12.77±3.10 ) 分、肌力 ( 10.38±1.13 ) 分和 CMS ( 33.88±4.08 ) 分分別增加到治療后 1 個(gè)月的 ( 8.00± 0.89 ) 分、( 12.96±1.40 ) 分、( 20.58±5.68 ) 分、( 13.50±1.24 ) 分、( 54.04±5.17 ) 分，治療后 3 個(gè)月增加更顯著，分別為 ( 11.08±1.47 ) 分、( 17.96±1.11 ) 分、( 30.46±4.43 ) 分、( 15.92±2.47 ) 分、( 75.42±6.35 ) 分，各指標(biāo)及 CMS 總分治療后 1 個(gè)月、3 個(gè)月分別和治療前比較，差異均有統(tǒng)計(jì)學(xué)意義 ( P＜0.05 )；但對(duì)照組各指標(biāo)及 CMS 總分治療后 1 個(gè)月和 3 個(gè)月均較治療前變化不大，差異均無(wú)統(tǒng)計(jì)學(xué)意義 ( P＞0.05 )。治療后 1 個(gè)月兩組組間比較，除肌力外，其它各指標(biāo)和 CMS 總分的差異均有統(tǒng)計(jì)學(xué)意義 ( P＜0.05 )；治療后 3 個(gè)月，兩組組間比較，各指標(biāo)及 CMS 總分差異均有統(tǒng)計(jì)學(xué)意義 ( P＜0.05 )。結(jié)論小劑量體外沖擊波治療非鈣化性岡上肌肌腱炎效果確切，能明顯減輕患者疼痛、提高患者日常生活能力、增加患者關(guān)節(jié)活動(dòng)度及肌力，對(duì)改善肩關(guān)節(jié)整體功能具有促進(jìn)作用，值得臨床推廣。

高能量沖擊波；體外光化學(xué)療法；肌腱?。豢祻?fù)；岡上肌

岡上肌肌腱炎是一種常見的運(yùn)動(dòng)損傷疾病，尤其好發(fā)于青、中年人[1]。目前常見的治療方法是運(yùn)用抗炎止痛藥、休息等保守治療，但效果并不是很好[2]。體外沖擊波是一種特殊形式的聲波，按治療劑量分級(jí)為小劑量、中劑量和大劑量[3]。在過(guò)去的20 年里，沖擊波被廣泛應(yīng)用于治療肌腱等軟組織疾病，如足底筋膜炎、網(wǎng)球肘和跳躍膝等[4-7]。已證實(shí)體外沖擊波對(duì)于鈣化性肌腱炎的臨床治療有效，但對(duì)于非鈣化性岡上肌肌腱炎的治療報(bào)道較少[8]。因此，回顧性分析 2011 年 4 月至 2013 年 4 月，我科收治的非鈣化性岡上肌肌腱炎患者 53 例，對(duì)其進(jìn)行體外沖擊波治療，并評(píng)價(jià)其治療效果。

資料與方法

一、納入及排除標(biāo)準(zhǔn)

納入標(biāo)準(zhǔn)：( 1 ) 經(jīng)體格檢查和 X 線片、MRI 篩查明確診斷是非鈣化性岡上肌肌腱炎者；( 2 ) 成年男性和未懷孕的女性；( 3 ) 傳統(tǒng)藥物和常規(guī)物理治療 3 周無(wú)效的者；( 4 ) 單側(cè)患病者；( 5 ) 患側(cè)肢體無(wú)關(guān)節(jié)粘連者；( 6 ) 自愿接受試驗(yàn)，簽署協(xié)議，全力配合者。

排除標(biāo)準(zhǔn)：( 1 ) 嚴(yán)重心功能不全或心臟起搏器植入者；( 2 ) 患 3 級(jí)高血壓病者；( 3 ) 有出血傾向、凝血功能障礙或在服阿司匹林者；( 4 ) 體質(zhì)過(guò)度虛弱者；( 5 ) 患側(cè)肩部有手術(shù)史或局部皮膚感染破潰者；( 6 ) 體內(nèi)有惡性腫瘤者；( 7 ) 對(duì)利多卡因過(guò)敏者；( 8 ) 高熱 38 ℃ 以上者。

二、一般資料

篩選 53 例，男 28 例，女 25 例，年齡 22～63 歲，平均年齡 ( 40.42±1.33 ) 歲。將 53 例分為治療組 26 例和對(duì)照組 27 例。兩組治療前基本情況相似，其中年齡、體重、病程、性別、患側(cè)左右人數(shù)、曾接受物理治療人數(shù)比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義 ( P＞0.05 ) ( 表 1 )。

三、干預(yù)和評(píng)定方法

兩組患者均接受紅外線治療，功率采用 15 W，距離病灶 60 cm，時(shí)間 15 min / 次，隔日 1 次，共15 次。治療組和對(duì)照組均在接受第 1 次和第 4 次紅外線治療的次日，分別接受實(shí)質(zhì)性的和安慰性的沖擊波治療。治療組采用廣州龍之杰公司 LGT2500B型體外沖擊波治療，采用 0.08 mJ / mm2，3000 次的脈沖劑量，在超聲波的引導(dǎo)定位下將治療點(diǎn)定在病患肌腱附著點(diǎn)近端 1 cm 處，治療 2 次，每次間隔 1 周[9]；對(duì)照組采用同樣的儀器，同樣的時(shí)間，但不發(fā)射沖擊波。兩組患者接受沖擊波治療前都將接受治療的部位伸到屏風(fēng)的另一側(cè)，在肩峰下注射2 ml 的利多卡因。試驗(yàn)前都告知患者治療過(guò)程中可能會(huì)出現(xiàn)的副作用和意外，包括治療區(qū)域下的血腫、瘀點(diǎn)、瘀斑、皮膚發(fā)紅甚至出血，治療后可能更加敏感而疼痛，突然昏倒，惡心嘔吐，心慌頭暈等。分別于初次接受沖擊波治療后的第 1 個(gè)月和第 3 個(gè)月進(jìn)行門診隨訪，采用 Constant-Murley 肩關(guān)節(jié)功能評(píng)定法 ( constant-murley score，CMS ) 量表對(duì)患者治療前和初次接受沖擊波治療后的第 1 個(gè)月和第 3 個(gè)月的肩關(guān)節(jié)整體功能狀況進(jìn)行評(píng)分，滿分100 分[10]，包括疼痛 15 分、日常生活能力 ( activity of daily living，ADL ) 20 分、關(guān)節(jié)活動(dòng)度 ( range of motion，ROM ) 40 分及肌力 25 分。

四、統(tǒng)計(jì)學(xué)處理

采用 SPSS 17.0 軟件對(duì)相關(guān)數(shù)據(jù)進(jìn)行處理。數(shù)據(jù)采用 (±s ) 表示，計(jì)數(shù)資料采用 χ2檢驗(yàn)，計(jì)量資料采用 t 檢驗(yàn)，多樣本均數(shù)比較采用方差分析，P＜0.05 表示差異有統(tǒng)計(jì)學(xué)意義。

結(jié) 果

所有病例均接受了治療，無(wú) 1 例在治療過(guò)程中出現(xiàn)嚴(yán)重的副作用。兩組均進(jìn)行了至少 3 個(gè)月的隨訪。治療前兩組組間各觀察指標(biāo)及 CMS 總分比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義 ( P＞0.05 )。治療組治療后各指標(biāo)均有顯著改善，治療后 1 個(gè)月各指標(biāo)評(píng)分和 CMS總分均較治療前增加，治療后 3 個(gè)月較治療前明顯增高，差異均有統(tǒng)計(jì)學(xué)意義 ( P＜0.05 )；但對(duì)照組各指標(biāo)和 CMS 總分治療后 1 個(gè)月和 3 個(gè)月均較治療前變化不大，差異均無(wú)統(tǒng)計(jì)學(xué)意義 ( P＞0.05 )。治療后 1 個(gè)月兩組組間比較，除肌力外，其它各指標(biāo)和CMS 總分差異均有統(tǒng)計(jì)學(xué)意義 ( P＜0.05 )；治療后3 個(gè)月，兩組組間各指標(biāo)及 CMS 總分比較，差異均有統(tǒng)計(jì)學(xué)意義 ( P＜0.05 ) ( 表 2～6 )。

表1 治療組與對(duì)照組一般資料對(duì)比 (±s )Tab.1 Comparison of the general information between the treatment group and the control group (±s )

表1 治療組與對(duì)照組一般資料對(duì)比 (±s )Tab.1 Comparison of the general information between the treatment group and the control group (±s )

項(xiàng)目 治療組 ( n＝26 ) 對(duì)照組 ( n＝27 ) P 值年齡 ( 歲 ) 41.31±10.33 39.56±9.07 0.514性別 ( 男 / 女 ) 14 / 12 14 / 13 0.884體重 ( kg ) 65.04±7.05 66.22±6.03 0.514病程 ( 天 ) 38.65±8.92 38.07±5.56 0.777患側(cè) ( 左 / 右 ) 13 / 13 13 / 14 0.781曾接受其它物理治療的人數(shù) 14 12 0.494

表2 兩組治療前和治療后 1 個(gè)月、3 個(gè)月疼痛情況比較 (±s ) Tab.2 Comparison of pain before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

表2 兩組治療前和治療后 1 個(gè)月、3 個(gè)月疼痛情況比較 (±s ) Tab.2 Comparison of pain before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

注：*表示治療后 1 個(gè)月和治療前比較；**表示治療后 3 個(gè)月和治療前比較Notice:*Meant the comparison of pain at 1 month after the treatment and before the treatment.**Meant the comparison of pain at 3 months after the treatment and before the treatment

治療后 1 個(gè)月 治療后 3 個(gè)月分?jǐn)?shù) ( 分 ) *P 值 分?jǐn)?shù) ( 分 ) **P 值治療組 2.08±0.80 8.00±0.89 ＜0.05 11.08±1.47 ＜0.01對(duì)照組 1.70±0.67 7.04±1.72 0.54 8.15±2.05 0.39 P 值 0.070 0.014 ＜0.01組別 治療前( 分 )

表3 兩組治療前和治療后 1 個(gè)月、3 個(gè)月 ADL 情況比較 (±s ) Tab.3 Comparison of the ADL scale score before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

表3 兩組治療前和治療后 1 個(gè)月、3 個(gè)月 ADL 情況比較 (±s ) Tab.3 Comparison of the ADL scale score before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

注：*表示治療后 1 個(gè)月和治療前比較；**表示治療后 3 個(gè)月和治療前比較Notice:*Meant the comparison of pain at 1 month after the treatment and before the treatment.**Meant the comparison of pain at 3 months after the treatment and before the treatment

治療后 1 個(gè)月 治療后 3 個(gè)月分?jǐn)?shù) ( 分 ) *P 值 分?jǐn)?shù) ( 分 ) **P 值治療組 8.65±1.65 12.96±1.40 ＜0.05 17.96±1.11 ＜0.01對(duì)照組 7.48±2.53 11.44±2.94 0.55 13.44±3.75 0.31 P 值 0.051 0.021 ＜0.01組別 治療前( 分 )

討 論

體外沖擊波是通過(guò)物理學(xué)機(jī)制介質(zhì) ( 氣體 ) 傳導(dǎo)的機(jī)械性脈沖壓強(qiáng)波，在醫(yī)療上應(yīng)用非常廣泛，主要用于治療骨關(guān)節(jié)疼痛、碎石和軟組織損傷。其主要適應(yīng)證有頸肩肌筋膜疼痛綜合征、椎間盤疾患相關(guān)癥狀、坐骨神經(jīng)痛、脊柱異常相關(guān)癥狀、頸肩痛、關(guān)節(jié)或韌帶異常所致相關(guān)癥狀、肩臂手疼痛綜合征、股骨轉(zhuǎn)子上肌腱炎、腰脊柱綜合征、膝關(guān)節(jié)炎、坐骨神經(jīng)痛等。

表4 兩組治療前和治療后 1 個(gè)月、3 個(gè)月 ROM 情況比較 (±s ) Tab.4 Comparison of the ROM scale score before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

表4 兩組治療前和治療后 1 個(gè)月、3 個(gè)月 ROM 情況比較 (±s ) Tab.4 Comparison of the ROM scale score before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

注：*表示治療后 1 個(gè)月和治療前比較；**表示治療后 3 個(gè)月和治療前比較Notice:*Meant the comparison of pain at 1 month after the treatment and before the treatment.**Meant the comparison of pain at 3 months after the treatment and before the treatment

治療后 1 個(gè)月 治療后 3 個(gè)月分?jǐn)?shù) ( 分 ) *P 值 分?jǐn)?shù) ( 分 ) **P 值治療組 12.77±3.10 20.58±5.68 ＜0.05 30.46±4.43 ＜0.01對(duì)照組 11.37±4.10 15.78±6.14 0.47 18.70±6.91 0.29 P 值 0.168 0.005 ＜0.01組別 治療前( 分 )

表5 兩組治療前和治療后 1 個(gè)月、3 個(gè)月肌力情況比較 (±s ) Tab.5 Comparison of the muscle strength grading score before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

表5 兩組治療前和治療后 1 個(gè)月、3 個(gè)月肌力情況比較 (±s ) Tab.5 Comparison of the muscle strength grading score before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

注：*表示治療后 1 個(gè)月和治療前比較；**表示治療后 3 個(gè)月和治療前比較Notice:*Meant the comparison of pain at 1 month after the treatment and before the treatment.**Meant the comparison of pain at 3 months after the treatment and before the treatment

治療后 1 個(gè)月 治療后 3 個(gè)月分?jǐn)?shù) ( 分 ) *P 值 分?jǐn)?shù) ( 分 ) **P 值治療組 10.38±1.13 13.50±1.24 ＜0.05 15.92±2.47 ＜0.01對(duì)照組 9.37±4.17 11.70±3.85 0.40 12.78±3.57 0.22 P 值 0.233 0.233 0.001組別 治療前( 分 )

表6 兩組治療前和治療后 1 個(gè)月、3個(gè)月 CMS 總分比較 (±s ) Tab.6 Comparison of the total CMS score before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

表6 兩組治療前和治療后 1 個(gè)月、3個(gè)月 CMS 總分比較 (±s ) Tab.6 Comparison of the total CMS score before the treatment and at 1 and 3 months after the treatment between the 2 groups (±s )

注：*表示治療后 1 個(gè)月和治療前比較；**表示治療后 3 個(gè)月和治療前比較Notice:*Meant the comparison of pain at 1 month after the treatment and before the treatment.**Meant the comparison of pain at 3 months after the treatment and before the treatment

治療后 1 個(gè)月 治療后 3 個(gè)月分?jǐn)?shù) ( 分 ) *P 值 分?jǐn)?shù) ( 分 ) **P 值治療組 33.88± 4.0854.04± 5.17 ＜0.05 75.42± 6.35 ＜0.01對(duì)照組 29.52±12.3745.89±13.69 0.41 53.96±14.38 0.21 P 值 0.092 0.002 ＜0.01組別 治療前( 分 )

體外沖擊波的鎮(zhèn)痛機(jī)制尚不清楚，但一般認(rèn)為其主要通過(guò)提高痛閾來(lái)減輕或緩解疼痛。原因主要有以下幾點(diǎn)：( 1 ) 體外沖擊波沖擊力比較大，可直接抑制神經(jīng)末梢細(xì)胞；( 2 ) 體外沖擊波可改變傷害感受器周圍化學(xué)介質(zhì)的組成，抑制疼痛向信息的傳遞；( 3 ) 體外沖擊波可改變傷害感受器對(duì)疼痛的接受頻率，一次緩解疼痛；( 4 ) 體外沖擊波可引起局部充血，從而加強(qiáng)炎癥的消退。

岡上肌肌腱位于肱骨頭、肩峰和喙間韌帶之間，在肩關(guān)節(jié)由內(nèi)收至外展的運(yùn)動(dòng)過(guò)程中，岡上肌肌腱與肱骨頭、肩峰和喙間韌帶的距離逐漸縮小，加上岡上肌肌腱本身的形態(tài)變厚，致使其在肩峰和喙間韌帶下方狹小的間隙中受到嚴(yán)重的擠壓和摩擦，繼而發(fā)生局部無(wú)菌性炎癥、撕裂，甚至鈣化。對(duì)于非鈣化性岡上肌肌腱炎的治療效果有零散報(bào)道，但循證醫(yī)學(xué)有力的證據(jù)不多[10]，因此我們進(jìn)行了短期隨訪觀察，以期觀察體外沖擊波治療非鈣化性岡上肌肌腱炎的臨床療效。本組結(jié)果顯示和其它傳統(tǒng)方法 ( 如熱療和肩峰下注射藥物 ) 比較，體外沖擊波治療使得患者在 CMS 評(píng)分和整體身體功能方面有明顯改善[11-12]。已有證明，激素對(duì)肌腱有損害作用，隨著時(shí)間的推移結(jié)果會(huì)更壞[13]。而體外沖擊波治療沒有報(bào)道嚴(yán)重的副作用，并且這種方法可以在復(fù)發(fā)情況下重復(fù)使用[14]。

由于那里沒有血管，我們定位在附著點(diǎn)近端1 cm 處[15]。研究證明，沖擊波能通過(guò)新生血管形成的過(guò)程促進(jìn)肌腱的血供[16]。小劑量的體外沖擊波能調(diào)整 NO 的合成[17]，而 NO 分子在血管張力、血管再生和肌腱變性的過(guò)程中發(fā)揮重要的作用。體外沖擊波治療軟組織疼痛的作用機(jī)制有幾種學(xué)說(shuō)，如機(jī)械波學(xué)說(shuō)、聲音震波學(xué)說(shuō)[18]，但治療肌腱炎的機(jī)制尚不很明確。

本組結(jié)果顯示：體外沖擊波治療非鈣化性岡上肌肌腱炎患者效果確切，因此該方法值得臨床推廣。但該方法也存在不足：容易受一些因素影響，如沖擊波儀器的損耗、脈沖的次數(shù)、每次發(fā)射對(duì)的點(diǎn)、每次治療的間歇等；而且樣本量小，容易增加誤差；選擇紅外線基礎(chǔ)治療也是出于人性化設(shè)計(jì)；本組隨訪時(shí)間短，無(wú)法觀察長(zhǎng)期的治療效果[19]。從實(shí)際情況看，不容易進(jìn)行長(zhǎng)期隨訪，因?yàn)槿绻颊? 個(gè)月還沒有明顯改善癥狀，就會(huì)選擇其它治療方法而放棄[2]。所以，體外沖擊波治療肌腱炎機(jī)制需要我們克服困難，更長(zhǎng)期的隨訪觀察來(lái)研究獲得。

[1]Milgrom C, Schaffer M, Gilbert S, et al. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br, 1995, 77(2):296-298.

[2]Green S, Buchbinder R, Glazier R, et al. Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and effcacy. BMJ, 1998, 316(7128):354-360.

[3]江明, 邢更彥. 體外沖擊波療法在骨組織及肌肉系統(tǒng)疾病中的應(yīng)用. 中國(guó)臨床復(fù), 2005, 9(2):191-193.

[4]Sems A, Dimeff R, Iannotti JP. Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. J Am Acad Orthop Surg, 2006, 14(4):195-204.

[5]Rompe JD, Schoellner C, Nafe B. Evaluation of low-energy extracorporeal shock-wave application for treatment of chronic plantar fasciitis. J Bone Joint Surg Am, 2002, 84(3):335-341.

[6]Ko JY, Chen HS, Chen LM. Treatment of lateral epicondylitis of the elbow with shock waves. Clin Orthop Relat Res, 2001, 387:60-67.

[7]Russo S, de Durante C, Gigliotti S, et al. Shock wave management of footballer’s tendinopathies. J Sports Traumatol Rel Res, 1999, 21:84-88.

[8]Schofer MD, Hinrichs F, Peterlein CD, et al. High- versus low-energy extracorporeal shock wave therapy of rotator cuff tendinopathy: a prospective, randomised, controlled study. Acta Orthop Belg, 2009, 75(4):452-458.

[9]邢更彥. 骨肌疾病體外沖擊波療法. 第1版. 北京: 人民軍醫(yī)出版社, 2007.

[10]Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987, (214):160-164.

[11]Giombini A, Di Cesare A, Safran MR, et al. Short-term effectiveness of hyperthermia for supraspinatus tendinopathy in athletes: a short-term randomized controlled study. Am J Sports Med, 2006, 34(8):1247-1253.

[12]Petri M, Dobrow R, Neiman R, et al. Randomized, doubleblind, placebo-controlled study of the treatment of the painful shoulder. Arthritis Rheum, 1987, 30(9):1040-1045.

[13]Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet, 2010, 376(9754):1751-1767.

[14]Wang CJ, Yang KD, Wang FS, et al. Shock wave therapy for calcifc tendinitis of the shoulder: a prospective clinical study with two-year follow-up. Am J Sports Med, 2003, 31(3): 425-430.

[15]Rothman RH, Parke WW. The vascular anatomy of the rotator cuff. Clin Orthop Relat Res, 1965, 41:176-186.

[16]Wang CJ, Wang FS, Yang KD, et al. Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res, 2003, 21(6):984-989.

[17]Gotte G, Amelio E, Russo S, et al. Short-time non-enzymatic nitric oxide synthesis from L-arginine and hydrogen peroxide induced by shock waves treatment. FEBS Lett, 2002, 520(1-3): 153-155.

[18]王江山, 何明偉, 倪家驤. 體外沖擊波疼痛治療的進(jìn)展. 中國(guó)康復(fù)醫(yī)學(xué)雜志, 2011, 26(8):788-789.

[19]Albert JD, Meadeb J, Guggenbuhl P, et al. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. J Bone Joint Surg Br, 2007, 89(3):335-341.

( 本文編輯：代琴 )

Clinical observation of extracorporeal shock wave therapy for chronic non-calcific tendinopathy of the supraspinatus

GU Yu-jing, LIN Song, FENG Xiao-dong. Department of Rehabilitation Medicine, the frst Affliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, 450000, PRC

ObjectiveTo observe the clinical effects of extracorporeal shock wave therapy ( ESWT ) for chronic non-calcific tendinopathy of the supraspinatus.MethodsFrom April 2011 to April 2013, 53 patients with chronic non-calcifc tendinopathy of the supraspinatus were adopted, whose average age was ( 40.42±1.33 ) years old. They were randomly divided into treatment group ( n=26 ) and control group ( n=27 ). The patients in both groups received infrared ray therapy. Besides, the patients in the treatment group received low-dose ESWT and the patients in the control group accepted placebo therapy. The Constant-Murley score ( CMS ) was used to assess the improvement of the shoulder function in both groups before the treatment and at 1 and 3months after the treatment.ResultsThe patients in both groups were followed up for at least 3 months, and no severe side effects were noticed during the treatment. In the treatment group, the scores of Visual Analogue Scale ( VAS ), activity of daily living ( ADL ) scale, range of motion ( ROM ) scale, muscle strength grading scale and CMS were ( 2.08±0.80 ) points, ( 8.65±1.65 ) points, ( 12.77±3.10 ) points, ( 10.38±1.13 ) points and ( 33.88±4.08 ) points before the treatment, which were increased to ( 8.00±0.89 ) points, ( 12.96±1.40 ) points, ( 20.58±5.68 ) points, ( 13.50±1.24 ) points and ( 54.04±5.17 ) points at 1 month after the treatment and ( 11.08±1.47 ) points, ( 17.96±1.11 ) points, ( 30.46±4.43 ) points, ( 15.92±2.47 ) points and ( 75.42±6.35 ) points at 3 months after the treatment. When all the scores stated above and the total CMS score before the treatment were compared with that at 1 and 3 months after the treatment respectively, statistically signifcant differences existed ( P＜0.05 ). However, when all the scores stated above before the treatment were compared with that at 1 and 3 months after the treatment respectively in the control group, no statistically significant differences existed ( P＞0.05 ). At 1 month after the treatment, there were statistically signifcant differences between the 2 groups in all the scores and the total CMS score except the muscle strength grading score ( P＜0.05 ). At 3 months after thetreatment, there were statistically signifcant differences between the 2 groups in all the scores and the total CMS score ( P＜0.05 ).ConclusionsThe low-dose ESWT is effective in the treatment of chronic non-calcifc tendinopathy of the supraspinatus, which can obviously alleviate pain of the patients, enhance their abilities in daily activities, increase the joint ROM and muscle strength and improve the overall function of the shoulder. It is worthy of clinical application.

High-energy shock waves; Photopheresis; Tendinopathy; Rehabilitation; Supraspinatus

10.3969/j.issn.2095-252X.2014.09.005

R686

450000 鄭州，河南中醫(yī)學(xué)院第一附屬醫(yī)院康復(fù)中心 ( 谷玉靜，馮曉東 )；香港理工大學(xué) ( 林松 )

2014-07-07 )